Provider Demographics
NPI:1053176644
Name:MINDFUL KEY PLLC
Entity type:Organization
Organization Name:MINDFUL KEY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVENISH
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:712-221-0684
Mailing Address - Street 1:930 W BLUFF ST
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:IA
Mailing Address - Zip Code:51012-1531
Mailing Address - Country:US
Mailing Address - Phone:712-221-0684
Mailing Address - Fax:
Practice Address - Street 1:930 W BLUFF ST
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:IA
Practice Address - Zip Code:51012-1531
Practice Address - Country:US
Practice Address - Phone:712-221-0684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty